Pluralism in the organisation of health services research

The variety of methods used in health services research (HSR) embody categorically different epistemological assumptions. These are examined in an effort to contribute to a usable framework for the evaluation of HSR projects, and in the light of a need in the U.K. for adequate institutional arrangements for the promotion and funding of HSR. Research into organisation has revealed that if desired values are not explicitly built into the structure, other values may appear unbidden. The adequate institutional base is one which embodies, espouses and funds a meaningful and practical scientific pluralism. A possible classification is outlined and illustrated and its implications for competition amongst scientists and the social responsibility of scientists are briefly discussed.     

Asking the right questions: Scoping studies in the commissioning of research on the organisation and delivery of health services

Scoping studies have been used across a range of disciplines for a wide variety of purposes. However, their value is increasingly limited by a lack of definition and clarity of purpose. The UK's Service Delivery and Organisation Research Programme (SDO) has extensive experience of commissioning and using such studies; twenty four have now been completed. This review article has four objectives; to describe the nature of the scoping studies that have been commissioned by the SDO Programme; to consider the impact of and uses made of such studies; to provide definitions for the different elements that may constitute a scoping study; and to describe the lessons learnt by the SDO Programme in commissioning scoping studies. Scoping studies are imprecisely defined but usually consist of one or more discrete components; most commonly they are non-systematic reviews of the literature, but other important elements are literature mapping, conceptual mapping and policy mapping. Some scoping studies also involve consultations with stakeholders including the end users of research. Scoping studies have been used for a wide variety of purposes, although a common feature is to identify questions and topics for future research. The reports of scoping studies often have an impact that extends beyond informing research commissioners about future research areas; some have been published in peer reviewed journals, and others have been published in research summaries aimed at a broader audience of health service managers and policymakers. Key lessons from the SDO experience are the need to relate scoping studies to a particular health service context; the need for scoping teams to be multi-disciplinary and to be given enough time to integrate diverse findings; and the need for the research commissioners to be explicit not only about the aims of scoping studies but also about their intended uses. This necessitates regular contact between researchers and commissioners. Scoping studies are an essential element in the portfolio of approaches to research, particularly as a mechanism for helping research commissioners and policy makers to ask the right questions. Their utility will be further enhanced by greater recognition of the individual components, definitions for which are provided.     

From theory to practice: improving the impact of health services research

Background  

While significant strides have been made in health research, the incorporation of research evidence into healthcare decision-making has been marginal. The purpose of this paper is to provide an overview of how the utility of health services research can be improved through the use of theory. Integrating theory into health services research can improve research methodology and encourage stronger collaboration with decision-makers.     

Does health technology assessment benefit health services and politics?

Health technology assessment (HTA) was introduced in Denmark 20 years ago. However, it only came into fashion a few years ago. This happened when politicians and health service decision-makers realized that due to the increasing pressure on resources prioritization was an inescapable fact. HTA was supposed to support this effort by providing a broad spectrum of information designed for decision-making. Events speeded up from that point on: a national HTA strategy, a national HTA institution, satellite institutions, and many HTA projects were set up – at national, regional, and local levels. The diversity and decentralization of decision-making combined with a broad and interdisciplinary approach to methodology guided the development of Danish HTA. Experiences with HTA were gained from successful applications and disappointing encounters with uncontrollable political processes. Politicians seem in general to be content with the development. An evaluation of the impact of HTA has not yet been undertaken, and a good deal of work lies ahead. The implementation of HTA results will be one of the greatest challenges of the years ahead.      

Epidemiology and assessment of health care services: new research trends

This article begins by analyzing the difficulty that Clinical Medicine, Epidemiology, and Health Planning and Administration have in dealing with the dynamic, complex social dimensions characterizing the technological organization of the diagnostic and therapeutic process, necessary for the production of health services' knowledge about diseases, a difficulty which has become more evident with the increasingly frequent and varied assessments in health care. The latest tendencies in "health services research" are analyzed, along with a priorization of effectiveness and outcomes, seeking to respond to the identified problems through a redefinition of objects and methodologies.     

From research to application: the development of an antenatal psychosocial health assessment tool

OBJECTIVE: To describe the development of an assessment tool for antenatal psychosocial risk factors associated with poor postpartum outcomes. METHODS: A survey of Ontario family physicians established a need for an antenatal psychosocial health assessment (ALPHA) form. A critical literature review identified important antenatal factors for inclusion on the form. Focus groups of obstetrical care providers indicated acceptance of the provider-completed ALPHA; their feedback led to the development of a self-report ALPHA. Satisfaction, yield and reliability of the self-report and provider-completed ALPHA forms were studied and found to be comparable. RESULTS: Physicians and patients reported good satisfaction and usefulness of the ALPHA form in identifying antenatal psychosocial risk factors. The provider ALPHA was further tested in clinical practice. ALPHA endorsement was obtained from physicians, nurses and midwives. CONCLUSION: A program planning process, which included multidisciplinary involvement, evaluation and endorsement by professional organizations, aided the development, refinement and application of the ALPHA forms as primary care tools. ALPHA topic headings are incorporated into the official 2000 Ontario Antenatal Record and the ALPHA adopted for use on Prince Edward Island.     

准确把握新时代我国公共卫生体系建设的概念及内涵

党的二十大报告强调人才是第一资源,并对全面推进健康中国建设、健全公共卫生体系提出了明确要求。“健康中国”战略提出实现“以健康为中心”,加强疾病预防和健康促进,使医疗和预防有效融合。群医学是运用、融合当代医学及相关学科的知识、技术、艺术和学术,作为公共卫生的医学基础,实现人群整体与长远健康效益最大化的一门医学学科。群医学人才队伍建设符合人才强国战略,群医学实践与健康中国建设趋向一致。本文分析探讨了群医学人才队伍建设的必要性与现实性,并通过总结和借鉴国外群医学人才培养的相关经验与实践,提出了我国群医学人才队伍建设的思考。     

From efficacy to public health impact: a call for research on program delivery and utilization in nutrition

Despite the high potential of nutrition interventions to save lives and to improve the quality of life of those who survive, programs are not being implemented effectively or at scale in most regions of the world. Research on delivery and utilization is urgently needed to fully unleash the potential of nutrition programs. The symposium sought to explore knowledge on determinants of delivery and utilization, demonstrate approaches for studying them, and highlight future research needs.     

Epidemiological applications to health services research

A model is presented to illustrate some areas in which epidemiological thinking may be applied to health services research. The model is neither exhaustive nor exclusive, for other areas not specifically described as within the model are also a part of the domain of epidemiology, and several aspects of the model are shared with researchers in other disciplines. Selected examples of epidemiological applications are reviewed; these include: (1) the impact of health programs on utilization patterns health services, (3) the impact of health programs on utilization patterns and on health status, and (4) the impact of therapeutic services on outcomes for specific diseases. Additional health services issues that are relevant to epidemiology are suggested.Dr. Hulka is Professor in the Department of Epidemiology at the School of Public Health, University of North Carolina, Chapel Hill, North Carolina 27514. This paper was prepared for presentation at the American Public Health Association Meeting in Miami, Florida, October 20, 1976.     

Community organization to enhance the delivery of preventive health services

Preventive health services are most effective when provided to large groups, but health care professionals often are limited to provision to individuals or small groups. As recent studies show, the effects of preventive services can be enhanced through the use of community organization, which mobilizes a community's energies and resources to define and address a problem in a way that promotes local ownership and generates increasing effects over time. We pragmatically adapt community organization for health care practitioners. There are three guiding principles: (1) the community of interest must be clearly defined; (2) existing community structures should be used to reach and stimulate community members; and (3) the organizer's role is temporary. We discuss four tactics of community organization: (1) use of community analysis to understand the community; (2) stimulation of community activity; (3) provision of concrete assistance to accomplish community change; and (4) reinforcement of structures that will remain to carry on the programs. Use of these community organization tactics will allow delivery of preventive health services in a way that promotes widespread and lasting effects.     

From women's health to gender-sensitive health research

Ohne ZusammenfassungProfessur Sozialepidemiologie mit dem Schwerpunkt Frauen und Gesundheit     

From public health research to health promotion policy: on the 10 major contradictions

Summary The rise of evidence-based medicine has given impetus to calls for more research evidence to be incorporated into health policy. The difficulty in effecting this research transfer has often been attributed to the different worlds of researchers and policy-makers. There are other contradictions, however, that must be addressed in attempting to bridge public health research and health promotion policy. These include such issues as: what forms of evidence are required, what types of research are usually funded, the limited scope and duration of health promotion programs, how health policies are formulated, contemporary public sector management reforms, and so on. These contradictions need to be recognized and managed if closer links are to be formed between public health research and health promotion policy.